Association of Neurocognitive Deficits With Radiotherapy or Chemoradiotherapy for Patients With Head and Neck Cancer

Zer, Alona; Pond, Gregory R.; Razak, Albiruni R. Abdul; Tirona, Kattleya; Gan, Hui; Chen, Eric X.; O’Sullivan, Brian; Waldron, John; Goldstein, David P.; Weinreb, Ilan; Hope, Andrew; Kim, John J.; Chan, Kelvin K.; Chan, Andrew K.; Siu, Lillian L.; Bernstein, Lori J.

doi:10.1001/jamaoto.2017.2235

Cited by 33 publications

(56 citation statements)

References 31 publications

(54 reference statements)

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“…With regard to focal CRT, studies have found the midline and medial temporal structures of the brain, especially the hippocampus and hypothalamus, to be more vulnerable to radiotherapy, although these regions are not as likely to have been exposed during radiation for STS. Nevertheless, neurocognitive deficits have been reported in patients with adult‐onset head and neck cancer after treatment with chemotherapy and/or radiation …”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, neurocognitive deficits have been reported in patients with adult-onset head and neck cancer after treatment with chemotherapy and/or radiation. 29 Having a moderate to severe neurologic condition was associated with both worse neurocognitive performance and poor HRQOL. The most common neurologic condition was peripheral neuropathy.…”

Section: Discussionmentioning

confidence: 99%

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Neurocognitive and psychosocial outcomes in adult survivors of childhood soft‐tissue sarcoma: A report from the St. Jude Lifetime Cohort

Olsson

Brinkman

Wang

et al. 2020

Cancer

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Background To the authors' knowledge, few studies to date have examined long‐term neurocognitive outcomes in survivors of childhood soft‐tissue sarcoma. Methods A total of 150 survivors (41% of whom were female with a mean current age of 33 years [SD, 8.9 years] and a time since diagnosis of 24 years [SD, 8.7 years]) and 349 community controls (56% of whom were female with a mean current age of 35 years [SD, 10.2 years]) completed comprehensive neuropsychological testing, echocardiography, electrocardiography, pulmonary function tests, endocrine evaluation, and physical examination. Patient‐reported outcomes of health‐related quality of life (HRQOL) and social attainment were collected. Survivors were compared with norms and controls on neurocognitive outcomes using general linear models, and on HRQOL and social attainment using modified Poisson models. The impacts of treatment and chronic health conditions on outcomes were examined using multivariable general linear models (effect size was expressed as unstandardized β estimates that reflected the unit of change from a mean of 0 and an SD of 1) and modified Poisson models (effect size expressed as relative risks). Results Compared with controls and population norms, survivors demonstrated lower performance on measures of verbal reasoning (mean z score, −0.45 [SD, 1.15]; P < .001) mathematics (mean z score, −0.63 [SD, 1.07]; P < .001), and long‐term memory (mean z score, −0.37 [SD, 1.14]; P < .001). Cumulative anthracycline exposure (per 100 mg/m2) was found to be associated with poorer verbal reasoning (β = −0.14 z scores; P = .04), reading (β = −0.09 z score; P = .04), and patient‐reported vitality (relative risk, 1.32; 95% CI, 1.09‐1.59). Neurologic and neurosensory chronic conditions were associated with poorer mathematics (neurologic conditions: β = −0.63 z score [P = 0.02]; and hearing impairment: β = −0.75 z scores [P < 0.01]). Better cognitive performance was associated with higher social attainment. Conclusions Long‐term survivors of soft‐tissue sarcoma are at risk of neurocognitive problems and poor HRQOL associated with anthracycline treatment and chronic health conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neurocognitive and psychosocial outcomes in adult survivors of childhood soft‐tissue sarcoma: A report from the St. Jude Lifetime Cohort

Olsson

Brinkman

Wang

et al. 2020

Cancer

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“…Longitudinal assessments of these participants, 67 both head and neck cancer and noncancer cohorts, are currently ongoing. Our findings suggest that objective cognitive functioning in patients with head and neck cancer is not impaired before treatment relative to healthy individuals, although subjective symptoms are, including cognition, fatigue, anxiety, and depression.…”

Section: Discussionmentioning

confidence: 99%

“…Still, multiple demographic factors, such as education level, smoking exposure, and history of concussion, are associated with a patient's risk of cognitive disturbance before treatment. Longitudinal assessments of these participants, 67 both head and neck cancer and noncancer cohorts, are currently ongoing.…”

Section: Discussionmentioning

confidence: 99%

Pretreatment neurocognitive function and self‐reported symptoms in patients with newly diagnosed head and neck cancer compared with noncancer cohort

et al. 2018

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Pretreatment patients with head and neck cancer reported cognitive disturbance. The frequency of impaired performance, albeit high, was consistent with the literature demonstrating false-positive "abnormal" neuropsychological test performance is not uncommon. Inclusion of a noncancer patient control cohort is essential because using solely normative data as a comparison may foster erroneous interpretation.

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“…Moreover, there is a risk for second primaries in HNSCC associated with cigarette smoking and excessive alcohol consumption . The aims of HNSCC follow‐up are early detection of recurrences and second primaries to enhance the chances for successful salvage therapy, the detection and management of treatment‐related sequelae, and psycho‐social support for the patients . However, the ideal structure of follow‐up is a matter of ongoing debate.…”

Section: Introductionmentioning

confidence: 99%

Patients' preferences concerning follow‐up after curative head and neck cancer treatment: A cross‐sectional pilot study

et al. 2019

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Background: Evidence of the oncological benefit of scheduled follow-up in head and neck squamous cell carcinoma is weak; symptom-oriented self-referral may be an alternative. Patients' preferences regarding follow-up remain poorly investigated. Methods: We conducted a cross-sectional survey among patients undergoing followup at a tertiary outpatient clinic, focusing on their preferences, correlating factors, fear of recurrence, and willingness for participation in a randomized trial on follow-up. Results: Of 101 patients, 89.1% preferred scheduled follow-up to self-referral, 57% favored fewer visits than the current standard, and 85.1% endorsed regular imaging. Recurrence or second primary was associated with preference of intensive followup schedules (P = 0.02). There were trends for women and patients with high fear of recurrence score to favor intensive follow-up. Two-third of the participants declared willingness to participate in a randomized controlled trial. Conclusions: Patients' preferences only partially correspond to current follow-up guidelines. Recruitment for randomized controlled studies evaluating the value of follow-up seems feasible. K E Y W O R D Sfear of recurrence, follow-up, head and neck cancer, patients' preference, selfreferral

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Association of Neurocognitive Deficits With Radiotherapy or Chemoradiotherapy for Patients With Head and Neck Cancer

Cited by 33 publications

References 31 publications

Neurocognitive and psychosocial outcomes in adult survivors of childhood soft‐tissue sarcoma: A report from the St. Jude Lifetime Cohort

Neurocognitive and psychosocial outcomes in adult survivors of childhood soft‐tissue sarcoma: A report from the St. Jude Lifetime Cohort

Pretreatment neurocognitive function and self‐reported symptoms in patients with newly diagnosed head and neck cancer compared with noncancer cohort

Patients' preferences concerning follow‐up after curative head and neck cancer treatment: A cross‐sectional pilot study

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